外伤性白内障后囊破裂人工晶体植入的手术方式选择

目的探讨外伤性白内障晶体后囊不存在时,采用前房型人工晶体植入,抑或后房型人工晶体巩膜缝线固定术。方法外伤性白内障患者８６例（８６只眼）,其中前房型人工晶体（新型弹性开放襻）植入５６例,Ⅰ期植入２９例,Ⅱ期植入２７例;后房型人工晶体巩膜缝线固定（大Ｃ型襻,两根缝线睫状沟固定）３０例,Ⅰ期植入１４例,Ⅱ期植入１６例。结果术后随访１～４２个月。矫正视力≥０．５者,前房型人工晶体组４０例,占７１．４％;缝线固定组２７例,占９０．０％。矫正视力≥１．０者,前房型人工晶体组２２例,占３９．３％;缝线固定组１４例,占４６．７％。结论新型前房型人工晶体植入和后房型人工晶体巩膜缝线固定术均不失为常规后房型人工晶体植入失败的补救措施,但前房型人工晶体适用于年龄较大、眼前段（角膜、虹膜和前房角）条件较好,而眼后段（玻璃体、视网膜）条件较差者;后房型人工晶体巩膜缝线固定术则适用于年龄较小、眼前段条件较差而眼后段条件较好者。

The choice of methods of intraocular lens implantation in traumatic cataract in the absence of capsular and zonular support

OBJECTIVE: To study the choice between the methods of anterior chamber intraocular lens (AC-IOL) implantation and posterior chamber IOL suture fixation in traumatic cataract without posterior capsular support. METHODS: The study included 86 cases (86 eyes) with traumatic cataract. A new flexible open-loop one piece PMMA IOL was implanted in the AC-IOL group of 56 cases (56 eyes); fixation of a C-loop one piece PMMA IOL at ciliary sulcus with two sutures was performed on 30 cases (30 eyes) in the posterior chamber IOL (PC-IOL) group. RESULTS: The follow-up period was 1 - 42 months. The visual acuity 0.5 or better was in 71.4% (40/56) in AC-IOL group, in 90.0% (27/30) in PC-IOL group; 1.0 or better was in 39.3% (22/56) in AC-IOL group, in 46.7% (14/30) in PC-IOL group. CONCLUSION: Both AC-IOL implantation and PC-IOL suture fixation are the remedy methods when the PC-IOL intracapsular implantation is unsuccessful. The AC-IOL is suitable for old persons with good anterior segment (cornea, iris and the angle of anterior chamber) and poor posterior segment (vitreous, retina) situations, while the PC-IOL suture fixation is suitable for the young with relatively poor anterior segment and good posterior segment conditions.